Key result
Therapeutic-dose warfarin plus aspirin linked to ~16% greater 7-year SVG patency versus lower INR.
Why the study?
Saphenous vein grafts frequently suffer from progressive failure after CABG, and it was hypothesized that therapeutic-dose warfarin plus aspirin could improve graft patency.
Does therapeutic-dose warfarin (INR >1.6) plus aspirin improve long-term patency of saphenous vein grafts in patients undergoing isolated CABG?
Cohort (n=199)
Does therapeutic-dose warfarin (INR >1.6) plus aspirin improve long-term patency of saphenous vein grafts in patients undergoing isolated CABG?
Absolute Event Rate: 92% vs 79%
p-value: p=0.00378
Maintaining an INR >1.6 with warfarin plus aspirin significantly improves long-term saphenous vein graft patency and reduces repeat revascularization after isolated CABG without increasing bleeding complications.
Therapeutic-dose warfarin plus aspirin was associated with higher SVG patency after CABG; leaves open need for randomized confirmation before practice change.
PURPOSE: Saphenous vein graft (SVG) is the most commonly used conduits in coronary artery bypass grafting (CABG), but the disadvantage of SVG is its tendency for progressive failure. We hypothesized that therapeutic-dose warfarin (international normalized ratio [INR] >1.6) plus aspirin improve SVG patency. This study aimed to evaluate the factors contributing to SVG patency. METHODS: Since 2010-2020, 199 patients who underwent isolated CABG using SVG were divided into two groups according to their INR values in the first year: group T (INR >1.6) and group L (INR <1.6). RESULTS: Group T had 162 SVGs (105 patients) and group L had 151 SVGs (94 patients). The 1-, 4-, and 7-year SVG patency rates were higher in group T than in group L (99%, 96%, and 92% vs. 93%, 86%, and 79%, respectively; p = 0.00378). The 1-, 4-, and 7-year freedom from repeat-revascularization was higher in group T than in group L (100%, 100%, and 99% vs. 98%, 95%, and 87%, respectively; p = 0.0264). Multivariate analysis showed that therapeutic-dose warfarin (p = 0.00204) and target vessel diameter (p <0.0001) were independent risk factors of SVG occlusion. CONCLUSION: Therapeutic-dose warfarin (INR >1.6) plus aspirin after CABG improved the long-term patency of SVG and decreased repeat-revascularization rate.
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Tasaki et al. (2022) conducted a cohort in Coronary artery bypass grafting (CABG) using saphenous vein graft (SVG) (n=199). Therapeutic-dose warfarin plus aspirin vs. INR <1.6 was evaluated on 7-year SVG patency rate (p=0.00378). Therapeutic-dose warfarin (INR >1.6) plus aspirin improved 7-year saphenous vein graft patency compared to INR <1.6 (92% vs 79%, p=0.00378).
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